“Well, medicine was mostly faith-healing when it came to it. And he had a good manner – he could inspire hope and belief.”
― Agatha Christie
Last week I spoke about a young man who had a remarkable recovery after I gave him a “pep talk.” I received many comments that I felt needed further discussion.
Although I prefer to avoid discussions on faith, religion, and miracles (like politics, they have the potential to induce divisiveness, and I want as much unity as possible in the doctor-patient conversation), some people asked if we could interpret the positive result as a miracle. Other, less devout people remarked that had we introduced a prayer into our “pep talk,” for sure there would be someone that would want to call this natural occurrence a result of supernatural influence.
We could spend a long time on this discussion. My preference is to derive joy and satisfaction from the fact that my patient is well, and to declare that there are things that happen, many things, that I don’t understand well and that I don’t have an explanation for. And I leave it at that. I’ve long ago given up on my youthful dream that some day we would have a complete fund of knowledge; that science would be king (or queen). I’ve resigned myself to allowing some mystery, maybe call it mysticism, into my life. It has not proven to be as traumatic an experience as I had feared it would be.
I have no question that attitude (both from patient and doctor) have a bearing on the final outcome of an illness. Change that: on the final outcome of a life. I remember the time that I had an unusually tough time trying to relieve a woman’s symptoms. Many tests had been run; many hours spent on long conversations. She bitterly complained that she felt no relief.
At the end of one of our appointments I wrote her a prescription; I explained that she could take the medicine for a two week trial, and that she should stop taking it if she failed to improve. As I handed the piece of paper to her she said: “That won’t help!”
I pulled the prescription back, and I tore it to pieces.
“You’re right. It won’t.” Her face showed a look of surprise.
“But I’ll take it!” she said.
“You already told me it won’t help. There’s no way it will if you don’t allow it to.”
Soon after that encounter she stopped coming to see me. I’d be surprised to find out that she finally got some relief.
Again, I don’t have a good explanation for this, but people have repeatedly shown me that they can respond to suggestion, many times in powerful ways. I remember reading about an “epidemic” of itching and hives that occurred in an elementary school. After many tests were run on many children, and there were no positive results, the CDC sent an investigative team to this school. Several experts were allowed to observe the class that was most often responsible for starting the wave of itches through the school. The class started innocently enough, but within a few minutes one of the students complained of being itchy. Soon a rash appeared. Within ten minutes most of the classmates had developed identical symptoms. All children felt better once they were removed from class and counseled individually.
There are well documented cases of mass hysteria; just think of the success Hitler and other evil leaders have enjoyed (including the many cases of mass suicides, or weddings). We cannot argue with the facts: we are suggestible beings. It’s up to both patient and doctor to use this significant power to our advantage.
I’ll close with a humorous example that involves me. I love smoked salmon. Recently I bought a pound at a local wholesale store. I ate a few pieces on my way to the gym. I had a great workout; I felt wonderful. After I got home I opened my e mail. I had received a note from the wholesaler: the salmon was being recalled because there was a possibility of contamination from a dangerous bacteria.
I printed the message. By the time I walked to show it to my wife I had developed nausea, queasiness, and sweats. I did not eat much that evening. I’m still hesitant to eat normal amounts of food, and I asked my doctor to write for some antibiotics just in case that I may need them during an upcoming trip (he wisely declined).
When I finally allowed myself to take stock of what had happened to me, I realized that I had been had, by my own body. Fortunately, my doctor listened and was kind enough to reassure me, and I was a good enough patient to be honest with him and allow him to see me at my hypochondriacal worst, without fearing that he would shame me or make fun of me.
In the end, that’s what we should all strive for. The results won’t always be cures, but we will have a stronger bond and we’ll be most satisfied with each other.
This Post Has 4 Comments
I like language and definitions. Reading your article I thought about the concept of “intentionality” in language and the use of words that can have an effect on others. In this case the much needed “healing words” that we want to hear from our doctor. We go to the doctor because we are sick, and many times have not found a solution to a physical/emotional problem, being pain or discomfort. Here I found a definition that could be interesting to explore: “Intentionality” is a philosophical concept defined by the Stanford Encyclopedia of Philosophy as “the power of minds to be about, to represent, or to stand for, things, properties and states of affairs.” The term refers to the ability of the mind to form representations and has nothing to do with intention. The term dates from medieval Scholastic philosophy, but was resurrected by Franz Brentano and adopted by Edmund Husserl. The earliest theory of intentionality is associated with St. Anselm’s ontological argument for the existence of God and his tenets distinguishing between objects that exist in the understanding and objects that exist in reality. So as you see, it is very difficult to run away from “natural” or “supernatural” order of words in language. There is always a runner from one side to the other. Communication requires “intersubjectivity” people must coincide in some point so there can be an exchange of meaning. The patient must believe that the doctor knows his subject, so he/she can submit to his adivce. In that case the words pronounced by the doctor could “represent an order of things of affairs” that the patient had not thought possible. For instance, a doctor affirms that the patient has a potential of a long and healthy life, if he takes x, y, z medicine. The outcome would vary if the patient believes the doctor, or not.
Querido Paco: Sigo de acuerdo con tu comentario… en la línea de mi madre: “estas cosas suceden”. Un abrazo. Javier
I also believe in the power of positive thinking. I think it can make you feel better medically and emotionally. I also feel that being around positive thinking people is better. Remember the saying “your cup is half full or half empty”. Cordell Webb
I concur. Before my diagnosis I believed that it was vitally important that I try to keep my activity level as close to normal as possible. I need to lose maybe about 10 more pounds (I will start this new year!), but I don’t look at medical advise as a negative, but as advise on how to improve my life. We all have mountains to climb and how we approach it can signal our success or failure. It may seem to be easier to say that it is too hard, but the joy in the accomplishment is worth it.